| NPI | 1114595824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LISA JOB Operations Manager 701-526-6530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2025-02-04 |